Clinical Issues Committee MD Liaison

Ann Rogers, MD FASMBS

Ad Hoc Members

Rachel Blind, NP-BC
Laura Campisi, MA
Pamela Davis, RN MBA CBN

ASMBS Staff Liaison

Leslie Vinson

Mission

The mission of the IH Clinical Issues and Guidelines Committee is to create evidence-based guidelines and position statements with focus on clinical issues related to the integrated multidisciplinary team as well as issues related to the individual Integrated Health disciplines with the goal of enhancing the safety, quality and outcomes of bariatric and metabolic surgical patient care.

Description

The ASMBS Clinical Issues and Guidelines Committee represents multiple disciplines of bariatric Integrated Health professionals with at least one member representing the following disciplines – nursing, behavioral health, nurse practitioner or physician assistant, registered dietitian, and pharmacist. The Committee members are appointed by the IHEC President with input from the Committee Chair and Co-Chair.​

Objectives

Identify, develop, and revise best practice recommendations, clinical guidelines, position statements and protocols for the different disciplines within Integrated Health; Review and reassess every 2 years

Identify and provide support to the committee/member(s) developing best practices, clinical guidelines, position statements and recommendations

Long-Term

Nutrition Guidelines: Macronutrients

Nutrition Guidelines: Pregnancy

Specific Projects that Achieve Goals and Objectives:

The IH Toolkit went live in June 2017 and a number of resources have been published; approved documents will continue to be added
a. Each bucket has an introductory section (landing page) and, where appropriate, folders for subsections
b. Five buckets (sections) are currently online (see below regarding the 6th bucket, Support Groups): Business Development & Service Line, Program Models & Structure, and Throughput were combined in August 2018, Clinical Guidelines, Facility Accommodations, Patient Education & Staff Education, Support Group – the IH Support Group committee is working with IHEC Patient Education Tool Kit Subcommittee in developing content for the Support Group section of the Tool Kit
c. A process has been established for IHCIG to provide new documents for IHEC to review for approval. As there are dozens of documents finalized and many more being edited and added, the flow through these reviews will be ongoing for the foreseeable future; materials will be made available through the online Tool Kit as they are finalized and approved by IHEC and other bodies whose approval are needed.
d. Some buckets are less robust than others due to committee members’ varying areas of expertise. The project would benefit from more expertise in business development and program structure and administration. Pam Davis has graciously offered some assistance with this, and we have recruited an ad-hoc member to help as well.

Sensitivity Guidelines reviewed by IHEC late 2016; awaiting further review/revision; project stalled as not enough research to create a “statement/guideline” but possibly a resource regarding sensitivity training

Online Psychosocial Evaluations: Status 4/2018 – As approved by EC and IHEC, an ad-hoc task force has been formed. A literature search has been conducted and the websites of the companies in question have been examined for potential areas of concern. The working group has created a survey to be sent to membership to learn more about members’ opinions and concerns regarding this practice. The idea is to create a paper, possibly for publication in SOARD, detailing member opinions on telepsychology evaluations and highlighting some of the pros/cons and concerns. The surgeons’ EC had some concerns about the survey, which we are working on learning more about the nature of their concerns and addressing them; one step we have taken is to enlist the collaboration of a member of the surgeons’ CIC to review and modify the survey; we are now waiting to hear more from surgeons’ EC.; see also collaboration project with surgeon CIC “Telemedicine in Post-Op Management”

Standardized protocol for Developing Guidelines/Position Statements: The Guideline for Developing Guidelines is in final draft and almost ready for full IH Clinical Issues and Guidelines Committee review and approval (this will likely occur just before Obesity Week). This document describes the recommended phases to be considered and/or used when developing clinical guidelines related to integrated disciplines. These Guidelines represent a comprehensive synthesis of currently existing guideline development guides or models, spanning multiple disciplines. A detailed description of a Position Statement, along with suggestions for creating Position Statements, is also included. Future work and next steps include providing examples for each of the guideline development phases to include brief instructions on executing each particular example.

Update of Gastric Banding Guidelines: A working group has been formed. One member of this group has been in contact with an industry rep for some input and has received some information. The committee is reviewing publications and online presentation. Very little new information is available. No training via vendor is readily available. The working group is moving forward with emphasis on experienced surgeons training their physician extenders and using their discretion. New guidelines will likely focus on patient assessment for adjustment versus technique. Because the scope of this project has shifted from a simple update of the previous document, we have involved Dr. Rogers, the chair of the surgeons’ CIC, in discussions about next steps. We have reached out to surgeons’ EC to make sure that they endorse this project. It may be that this project gets “spun off” to a dedicated task force, rather than staying within the umbrella of IH or surgeons’ CICs.

IH Collaboration on some surgeon CIC projects – Stephanie, Katie and Kasey had a conference call with the surgeons’ CIG chair and co-chair, to discuss the projects that the 2 committees are working on and determine areas in which IH CIG might assist with or take on various projects that fall within the purview of IH.
a. Weight Bias and Discrimination Project: Kasey has a special interest in this topic and has volunteered to work with the members of surgeons CIC who are working on this project. She has participated in one conference call to date. Authors from the surgeon CIC have begun working on a draft of the main points and will be sending them to Kasey in the coming weeks.
b. Telemedicine in Post-Op Management: Surgeons’ CIC is considering a project looking at using telemedicine for bariatric team members to follow their own patients after surgery; this is a slightly different topic from the one being looked at by the “Online Psych Evaluations” working group, but the two topics might be able to be addressed in one document. This will be followed up as we learn more about how we will be progressing with the “online psych eval” project.

Nutrition Guidelines: Macronutrients: A working group has been formed, including some ad-hoc members who are not part of CIG. This group has created a preliminary outline and completed their literature review, and each member of this work group has started writing their sections.

Nutrition Guidelines: Pregnancy: A three-person working group has been formed, one member of whom is ad hoc. A preliminary outline has been created and a preliminary literature review. 133 articles were identified. The working group created PICO questions and reviewed the literature. The issue they have run into is that there is very little published evidence available; they have discussed with Julie Parrot and Karen Flanders, and the guidance they have been given is that instead of guidelines, they will instead do a “recommendations” paper (akin to what was done for psych). They expect the second lit review to be done by the end of September (getting help from Kara Kallies) and target date for completion is Q22019.

2018 Completed Projects

The IH Toolkit went live in June 2017 – several modifications were made and many resources were added throughout 2018. Resources will continue to be added to the Toolkit as they are approved by IHEC and EC.